Hemond Christopher C, Dundamadappa Sathish K, Deshpande Mugdha, Baek Jonggyu, Brown Robert H, Ionete Carolina, Reich Daniel S
Departments of Neurology, University of Massachusetts Memorial Medical Center and University of Massachusetts Chan Medical School, Worcester, MA, USA.
Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
medRxiv. 2024 Aug 15:2024.08.14.24312000. doi: 10.1101/2024.08.14.24312000.
Paramagnetic rim lesions (PRL) are an emerging biomarker for multiple sclerosis (MS). In addition to associating with greater disease severity, PRL may be diagnostically supportive.
Our aim was to determine PRL specificity and sensitivity for discriminating MS from its diagnostic mimics using real-world clinical diagnostic and imaging data.
This is a retrospective, cross-sectional analysis of a longitudinal cohort of patients with prospectively collected observational data. Patients were included if they underwent neuroimmunological evaluation in our academic MS center, and had an available MRI scan from the same clinical 3T magnet that included a T2*-weighted sequence with susceptibility postprocessing (SWAN protocol, GE). SWAN-derived filtered phase maps and corresponding T2-FLAIR images were manually reviewed to determine PRL. PRL were categorized as "definite," "probable," or "possible" based on modified, recent consensus criteria. We hypothesized that PRL would convey a high specificity to discriminate MS from its MRI mimics.
580 patients were evaluated in total: 473 with MS, 57 with non-inflammatory neurological disease (NIND), and 50 with other inflammatory neurological disease (OIND). Identification of "definite" or "probable" PRL provided a specificity of 98% to discriminate MS from NIND and OIND; sensitivity was 36%. Interrater agreement was almost perfect for definite/probable identification at a subject level.
PRL convey high specificity for MS and can aid in the diagnostic evaluation. Modest sensitivity limits their use as single diagnostic indicators. Including lesions with lower confidence ("possible" PRL) rapidly erodes specificity and should be interpreted with caution given the potential harms associated with misdiagnosis.
顺磁性边缘病变（PRL）是多发性硬化症（MS）一种新出现的生物标志物。除了与更高的疾病严重程度相关外，PRL可能对诊断有辅助作用。
我们的目的是利用真实世界的临床诊断和影像数据，确定PRL在鉴别MS与其诊断模拟疾病方面的特异性和敏感性。
这是一项对具有前瞻性收集观察数据的纵向队列进行的回顾性横断面分析。如果患者在我们的学术性MS中心接受了神经免疫学评估，并且有来自同一临床3T磁体的可用MRI扫描，其中包括带有磁化率后处理的T2*加权序列（SWAN协议，GE），则纳入研究。对SWAN衍生的滤波相位图和相应的T2-FLAIR图像进行人工检查以确定PRL。根据修订后的最新共识标准，将PRL分为“确定的”、“很可能的”或“可能的”。我们假设PRL在鉴别MS与其MRI模拟疾病方面具有高特异性。
共评估了580例患者：473例MS患者、57例非炎性神经疾病（NIND）患者和50例其他炎性神经疾病（OIND）患者。识别“确定的”或“很可能的”PRL在鉴别MS与NIND和OIND方面的特异性为98%；敏感性为36%。在个体水平上，确定/很可能识别的观察者间一致性几乎完美。
PRL对MS具有高特异性，可辅助诊断评估。适度的敏感性限制了它们作为单一诊断指标的应用。纳入可信度较低的病变（“可能的”PRL）会迅速降低特异性，鉴于误诊相关的潜在危害，应谨慎解释。
